What is it about addiction that makes it so hard to put out? It is like a fire that is fed by some invisible source. It seems like you have put it out, and then perhaps months or years later, it flares up again. When it comes back, it burns more fiercely than ever, like a gasoline fire. What is it about the diseases of addiction that makes them flare up, over and over again? What makes them show up in the first place?
All addiction is about pain relief. Addiction to any substance or behavior is about getting rid of some kind of pain. It may not be physical pain, and often it is not (even if it starts out that way). There is always psychic pain, or emotional pain that makes alcohol, or any other mind-altering substance, feel good. It is necessary for us to feel bad in order for the pattern of addiction to feel good.
Studies have looked at what traits might be used to identify school children who are at risk for addiction. There are four traits that stand out. First is the trait of “sensation-seeking” which can be measured – these are kids who are bored easily, and want something new. Another trait is “impulsiveness”. The old test for impulsiveness used to be the marshmallow test. Put a kid in a room with a marshmallow on the table, and tell him not to touch it. Tell him that if he leaves it alone while you are gone, then he can have two marshmallows when you get back. Then leave. A kid who is impulsive can’t delay the gratification: the marshmallow is consumed immediately. Positive marshmallow test. Then there is the trait of “anxiety sensitivity”. It is not only being anxious, but it is about being conscious of being anxious, and being afraid of being anxious. And finally, there is “hopelessness”. It is the feeling that nothing is going to get any better.
So what could be underneath these traits? Pain. The pain could be the loneliness and anxiety that come from ADHD, and that manifest as impulsiveness and sensation seeking. The pain could be anxiety sensitivity as a symptom of a panic disorder, anxiety disorder, or PTSD. The pain of hopelessness is often a symptom of underlying depression. The emotional pain of underlying mental illness is enough to drive addiction. And if psychic pain isn’t addressed, it will persist enough to give addiction an encore.
On the other hand, when high risk kids with these four traits were offered help in a prevention workshop called Preventure, the binge drinking fell by 43 percent. Success is all about paying attention to whatever is going on, inside. Such interventions for at-risk students are becoming more common. A recent documentary “Paper Tigers” described a similar approach to at-risk students who have a history of substance abuse, in a high school in Walla Walla. In this program, discipline was tailored to avoid re-traumatizing students who are struggling at school. Teachers were taught to see beyond the substance abuse and see the adverse childhood experiences that fueled the pain-relief behavior. This program also found dramatic success in helping at-risk teens to avoid addiction, stay in school, and to graduate. Recognition of pain, and healing it fuels recovery.
I live in a small town that on a recent survey, gained national attention. Elmira has the highest number of prescription abusers in the country, according to a study done by Castlight, a medical data company that studies outcomes. Castlight defined an opiate abuser as someone with more than a 90 day cumulative supply of drugs, prescribed by four or more providers over the course of five years. Findings like these have spurred state-wide initiatives to educate doctors about the dangers of prescribing opiates, and careful internet-based monitoring of who gets an opiate prescription, and from which doctor. But Elmira, and even New York State is only the tip of the iceberg. The CDC calls opiate addiction an epidemic and estimates that nearly 2 million Americans are abusing or dependent on prescription painkillers.
It is true that opiates result in physical dependance in all human beings if they are taken regularly for a week or more, but not every adult who is provided with an opiate prescription becomes an addict. Opiates are used to provide pain relief for physical pain. But what if someone with physical pain also is living with the emotional pain of PTSD, depression, ADHD, or anxiety? Their risk of addiction in these adults is surely higher, just as it is in high school students.
The hallmark of all addiction is relapse. Addiction flares up like a gasoline fire, unless the underlying pain is addressed. This is why drug and alcohol treatment centers like the Caron Foundation have created programs like Breakthrough, to help clients on an inward journey. It is the journey inward that helps us to understand our pain, and heal it.